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In 90-95 % of cases, urothelial cancer primarily affects the bladder and in about 5-49 % of patients it can be located near or completely close the orifice of the ureter. Metachronous urothelial cancer of the upper urinary tract occurs, as a rule, 3 or more years after transurethral resection of the primary bladder tumor or radical cystectomy, and its frequency with involvement of the ureteral orifice ranges from 0 to 20 %, reaching 51 %. Currently, there are no clear recommendations and diagnostic and treatment algorithm for the management of this category of patients. This review examines the frequency, possible causes and risk factors for recurrence of upper urinary tract tumors, indications for organ-preserving treatment, features of surgical technique for transurethral resection of ureteral orifice tumors, emerging complications and methods of their prevention.

Purpose of the study. To assess the clinical and prognostic significance of serum and urinary cystatin C (uCys-C and sCys-C) in patients undergoing radical cystectomy (RC) in relation to AKI.Patients and methods. In this prospective study, uCys-C and sCys-C levels were measured during the first week after undergoing RC in a heterogeneous group of patients undergoing RC (n=186), mean age 59.5±11.4 years. The observation period of the patients was 6 months. The diagnosis of AKI that developed within the first week after surgery was based on the KDIGO criteria.Results. Of the 186 examined patients, 43 developed AKI according to generally accepted criteria. During the follow-up period, no patient required renal replacement therapy. AKI patients had a longer hospital stay (22.4±22.9 versus 13.0±4.1). The sCys-C levels were significantly associated with the occurrence of AKI and CKD in the long-term postoperative period and had an area under the ROC curve of 0.76 and 0.81, respectively, for predicting severe outcomes. At an optimal cut-off value of 161.17 ng/ml, sCys-C showed a sensitivity of 65 % and a specificity of 58 % for predicting AKI. The greatest increase in the concentration of sCys-C was detected 6-12 hours after surgery, followed by a decrease in the long-term follow-up.Conclusion. Peak sCys-C levels are associated with AKI and independently predict the development of AKI in patients after RC and the onset of CKD within 6 months.

This review aims to summarize the latest data on the treatment of bladder cancer published during the specified period. Most of them are evidence-based and were obtained in randomized trials. A new classification based on molecular data was proposed at a consensus meeting of pathologists. A significant correlation has been demonstrated between life expectancy and morphological structure of the tumor. This article covers chemotherapy regimens for patient with BCG (Bacillus Calmette-Guerin) intolerance. Immunotherapeutic agents for muscle-invasive bladder cancer are being actively studied now; scientists are searching for the best treatment regimens with these drugs and their combinations with other antitumor agents. The European Association of Urology has developed a new classification of intraoperative adverse events and recommendations for pharmacotherapy and surgical treatment of patients with bladder cancer during the COVID-19 pandemic. In conclusion, the opinions of experts from the consensus meeting on the treatment of various forms of bladder cancer are given.

Patients who practice Islam often refuse the proposed type of treatment for malignant neoplasms, citing religious reasons. Most fear that complete or partial non-retention of urine, the presence of a urostoma (ileal conduit) will violate their ritual purity and, as a result, their religious duties. The consequence of such refusal of treatment may be a lower quality of life, compared with patients of other faiths. Unfortunately, a low awareness of religious responsibilities among surgeons performing pelvic exentesis, cystectomy, prostatectomy, may prevent a full-fledged discussion of these issues before surgery. The presented review of the literature examined studies, legal aspects, and religious arguments that assist doctors in choosing treatment tactics for patients.

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p 0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p

Radical cystectomy (RC) remains the main surgical treatment for patients with muscle-invasive bladder cancer. Currently, robot-assisted access is actively used along with the open one. The review analyzes the main results of robot-assisted RC and compares them with those after open RC. We evaluated the following parameters of robot-assisted RC: surgery duration, volume of blood loss, terms of patients’ hospitalization, 30- and 90-day complications. We also compared the results of extra- and intracorporeal urine diversion and found out that intracorporeal ileal conduit formation and orthotopic cystoplasty are more advantageous. Gaining experience allows us to reduce the number of postoperative complications, especially severe ones according to Clavien classification, and to improve the functional results of robot-assisted RC.

Introduction. The feasibility of reconstructing an orthotopic urinary reservoir after radical cystectomy (RCE) in women is still debatable. This is due to the peculiarities of the physiology and anatomy of the female lower urinary tract and an increased risk of developing urinary incontinence or urinary retention after surgery.Purpose of the study. Studying long-term functional results of creating an orthotopic urinary reservoir by VIP in comparison with the technique of creating a urinary reservoir by Studer after RCE in women.Materials and methods. The study included 32 women who underwent RCE with the formation of an orthotopic urinary reservoir by to Studer — 13 patients and a «spherical» reservoir in the VIP — 19 modification. At the time of surgery, the age of patients was 61.1±1.9 years (29 ‒ 82). The average follow-up time was 77.5±7.8 months (17 ‒ 157, median 82). The patients who underwent a more complex type of plastic were younger than the patients operated on by the Studer method (p = 0.014). The groups did not differ statistically in other parameters.Results. The overall five-year survival rate in the Studer group was 90.9%, and in the VIP group — 94.7% (p = 0.596). 59.4% of patients were completely continent. Women after plastic surgery by VIP held urine better (68.4% vs 46.2%). The incidence of mild urinary incontinence was higher after Studer surgery. The incidence of severe urinary incontinence was the same in both groups. Nighttime urinary incontinence was the same in both groups. Intermittent catheterization was used more often by patients after VIP plastic surgery than after Studer surgery (21% vs 7.7%). In urodynamic studies, it was shown that the lower physiological capacity of the reservoir according to Studer due to more intense peristalsis of the reservoir wall, which causes involuntary leaking of urine, hyperperistalsis of the reservoir and a higher frequency of urinary incontinence causes more complete emptying in patients less residual urine, less need for self-catheterization. In the group of patients with plastic surgery according to VIP, a high physiological capacity of the reservoir with a lower pressure of the walls of the reservoir during the filling phase was recorded. This is manifested by a lower incidence of urinary incontinence, and, at the same time, a more significant amount of residual urine and a higher need for patients for self-catheterization.Conclusion. The formation of an orthotopic urinary reservoir with favourable long-term results is possible in women after RCE. The most beneficial in terms of the quality of daily held urine is the VIP modification, which is characterized by sufficiently high capacity and low intraluminal pressure. However, with this method of surgery, the risk of hypercontinence increases, which requires periodic catheterization. A complex urodynamic study made it possible to show the direct effect of various characteristics of the reservoir on the nature and degree of impaired urination of patients.

Radical prostatectomy and cystectomy with pelvic lymphatic dissection are the most common operations in oncourology. Development of lymphatic complications, such as lymphocele, lymphorrhea and lymphedema, often complicates their implementation. However, not all lymphatic complications manifest themselves clinically and require surgical treatment. There are many risk factors and methods for preventing lymphogenic complications during oncourological operations in the pelvic area. In this article, we will review potential provocative factors that should be considered when performing oncourological interventions in the pelvis, as well as methods for their prevention, which can minimize the lymphogenic complications.

Background . Bladder cancer is one of the most common cancers. Non-muscle-invasive bladder cancer is characterized by the high frequency of recurrence after radical treatment (up to 50–60 %), and muscle-invasive bladder cancer has a lower recurrence rate (30 %). Primary metastatic bladder cancer (Bc) is detected in 10–15 % of cases. transurethral resection of the bladder is the main treatment modality for non-muscleinvasive Bc. For muscle-invasive Bc, radical cystectomy is the curative treatment of choice. chemotherapy is used for the treatment of metastatic Bc. the role of surgery for metastatic Bc has not yet been determined. there are only a few reports regarding multimodality treatment including metastasectomy for metastatic Bc. Case description . We present a clinical case of successful treatment of metastatic Bc, we used surgery, radiotherapy, chemotherapy and x-ray endovascular technologies. the patient is alive with no evidence of disease. Conclusion . Our findings are consistent with other reports which indicate that the removal of metastases in patients with advanced urothelial carcinoma is technically feasible and can be safely performed. Metastasectomy can have a positive effect on survival. However, metastasectomy remains the subject of clinical studies, and should be recommended only for patients a good response to systemic therapy.

Background. Radical cystectomy uses laparoscopic and robotic approaches along with the open ones.Objective: to study immediate results of robot-assisted radical cystectomy with intracorporeal orthotopic cystoplasty.Materials and methods. Robot-assisted radical cystectomy with intracorporeal orthotopic cystoplasty was performed in 15 patients (13 male, 2 female), aged 64–76 years. Fourteen patients had bladder cancer, 1 female – a postradiation bladder fistula and microcystis. T2 stage was detected in 8 (57.1 %) patients, T3 – in 6 (42.9 %). After the operation we evaluated operation time, blood loss volume, hospital stay, functional and oncological results.Results. Average operation time was 380 (320–560) minutes, blood loss volume – 80–200 ml, blood transfusion was not performed. Early complications (up to 30 days) were observed in 7 patients (46.7 %), late ones (90‑days) – in 6 (40.0 %). There were no cases of intestinal obstruction. Patients with ureteral-intestinal (n = 2) and reservoir-urethral (n = 1) anastomosis failure underwent percutaneous renal drainage. One patient died of acute myocardial infarction. Daytime continence was 80.0 %, nocturnal – 53.3 %. One patient died of disease progression within 7.6 observation months.Conclusion. Robot-assisted radical cystectomy with intracorporeal urine diversion is a modern and minimally invasive method for patients with muscle-invasive bladder cancer. More experience in this field will allow to reduce surgery time and number of complications.

Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world. Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion. Materials and methods . Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis. Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%. Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types.

Purpose: to evaluate the influence of postoperative lymphatic leakage volume and duration on homokinesis and incidence of postoperative complications in oncosurgury patients underwent different operative interventions.Material and methods. The results of treatment of 310 patients subjected to standard elective surgical intervention for a malignant pathology of different organs with regional lymph node dissection were evaluated. The selection criterion was prolonged (more than 7 days) and prominent (over 50 ml a day) lymphatic leakage during the postoperative period. The fluid discharged during the postoperative period was identified as a lymph by cytology. The diagnosis of a malignant pathology was verified in all patients after histological examination and patients were distributed according to established diagnosis.Results. The duration of lymphatic leakage including the outpatient treatment stage varied from 9 days to 1 year and 2 months depending on the type of surgery. The longest lymphatic leakage occurred in 2 patients after radical mastectomy. During the 1st week of observation in patients with daily lymph losses up to 100 ml, no changes in the blood composition were noted. Prolonged lymphatic leakage (1–2 weeks after operation) in a volume over 100 ml a day resulted in reduced protein content in blood plasma, severe lymphocytopenia, increased platelet count. During the postoperative period, complications were detected in 31 patients; at that, during the 1st week of observation, 27 patients experienced initial lymphatic leakage over 100 ml a day. Analysis of fatal outcomes (7 patients) showed that in all patients the lymphatic leakage exceeded 150 ml a day and lasted 1 to 2 weeks. The longest inpatient time was typical for patients after Wertheim's hysterectomy and cystectomy, whereas the longest outpatient treatment was experienced by patients after radical mastectomy and inguinofemoral lymph node dissection.Conclusion. In case of lymphatic leakage over 100 ml a day in oncosurgury patients, it was necessary to make up protein losses and after 7 days of persistent lymphatic leakage it became necessary to consider use of active surgical tactics aimed at liquidation of lymph losses.

Objective : to study the frequency of surgical complications and postoperative mortality after radical cystectomy (RCE). Material and methods . In study included 107 patients who underwent RCE by one surgeon. Starting in 2015, the protocol for accelerated recovery of patients after surgery, ERAS was applied in all patients undergoing RCE. The frequency of complications and mortality was studied depending on the age of the patients and the ERAS protocol. There were 84 male (78.5 %) and 23female (21.5 %) in this study. All patients were divided into 2 groups: 1st group — 89 (83.0 %) people younger 75 years and 2nd group — 18 (17.0 %) people from 75 years and older. Depending on the application of the ERAS protocol, patients in each group were divided into 2 subgroups. Group 1st consists of subgroups: 1(A) — 40 (45.0 %) patients with ERAS protocol, 1(B) — 49 (55.0 %) patients without ERAS protocol. Group 2nd also consists of subgroups: 2(A) — 8 (44.4 %) patients with ERAS protocol, 2(B) — 10 (55.6 %) patients without ERAS protocol. The average age of the patients was 65.5 (32—85) years. Results . Totally, over the 90-day period after the operation, 55 cases (51.4 %) of complications were recorded: Clavien—Dindo I—II in 1st group — 27 (30.3 %), in 2nd group — 8 (44.4 %). Complications of Clavien—Dindo III—IV in the 1st group — 15 (16.8 %), in the 2nd group — 5 (27.7 %). The overall 90-day mortality was 10 cases (9.3 %): in 1st group — 8 (9.0 %) patients, in 2ndgroup — 2 (11.1 %) patients. According to the comparative study of the use of the ERAS protocol in subgroup 1(A), the incidence of complications of the Clavien—Dindo I—II category was noted in 11 (27.5 %) patients, and in subgroup 1(B) in 16 (32.6 %) patients. Complications of Clavien—Dindo Ш —IV in subgroup 1(A) were observed in 5 (12.5 %) patients and in subgroup 1(B) — in 10 (20.4 %) patients; in subgroup 2(A), the incidence of Clavien—Dindo I—II complications was noted in 3 (37.5 %) patients, and in subgroup 2(B) — in 5 (50.0 %) patients. Complications of Clavien— Dindo III—IV in subgroup 2(A) were observed in 2 (25.0 %) patients and in subgroup 2(B) — in 3 (30.0 %) patients. Thus, the ERAS protocol decreased the number of complications in the subgroup 1(A) compared to the subgroup 1(B) (z = 1.44; p = 0.08) and between the subgroup 2(A) and 2(B) (z = 1.39; p = 0.09). Also there was an increase in the number of complications in older subgroups: in subgroup 2(B) compared with subgroup 1(B) (z = 1.86; p = 0.068). The 90-day mortality in subgroup 1(A) was in 3 (7.5 %) cases, 1(B) — 5 (10.2 %) cases. The 90-day mortality in subgroups 2(A) was in 1 (12.5 %) case, in subgroup 2(B) was 1 (10.0 %) cases. Repeated hospitalization for the first 90 days was 14 (13.0 %) cases, with differences in the frequency of rehospitalization depending on age and application of the ERAS protocol. Conclusion . RCE is an acceptable method of treatment in patients of the older age group and should be performed in hospitals with experience of regular treatment of this nosology. Application of the ERAS protocol (accelerated recovery after surgery) in patients undergoing RCE allows, regardless of age, to reduce the incidence of early postoperative surgical complications and mortality.

Проанализированы результаты лечения 143 больных, которым выполнена цистпростатэктомия или передняя надлеваторная эвисцерация малого таза по поводу инвазивного рака мочевого пузыря или местно-распространенного рака шейки, тела матки, и рака яичников. Сопоставлены характеристики послеоперационного периода двух групп пациентов – у которых операции заканчивались традиционным дренированием через переднюю брюшную стенку (n = 71), и двухсторонним промежностным дренированием (n = 72). Полученные результаты свидетельствуют, что после операций на органах малого таза, сопровождающихся цистэктомией и расширенной подвздошно-тазовой лимфодиссекцией, двухстороннее промежностное дренирование в сочетании с реконструкцией брюшины боковых стенок таза улучшает послеоперационное восстановление кишечной перистальтики, способствует более раннему снижению интенсивности болевого синдрома и уменьшению частоты развития осложнений в раннем послеоперационном периоде. Промежностная установка дренажей является простой в исполнении и безопасной процедурой. Ее применение после операций на органах малого таза сопровождающихся цистэктомией с расширенной лимфаденэктомией позволяет выполнять данные вмешательства более безопасно., Results of treatment of 143 patients who underwent cystprostatectomy or anterior pelvic exenteration. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 71), and bilateral perineal drainage (n = 72). Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Installation is simple perineal drainage performed and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy., Вестник Национального медико-хирургического Центра им. Н.И. Пирогова, Выпуск 2 2021, Pages 32-36

Цель работы: представление клинического случая успешного применения лапароскопической цистэктомии с интракорпоральным формированием ортотопического мочевого пузыря по методу U. E. Studer в лечении пациента с мочепузырным болевым синдромом. Материалы и методы: Все этапы операции, были выполнены интракорпорально. Первым этапом выполнена лапароскопическая гистерэктомия. После удаления матки из брюшной полости начата мобилизация по передней стенке мочевого пузыря. По намеченной границе, резецированная тонкая кишка прошита аппаратным швом и пересечена. Мобилизованный сегмент присоединён к мочеполовой диафрагме с помощью непрерывного шва «Rocco Stitch», далее вскрыт на всём протяжении. Следующим этапом сформирован энтероцистоуретроанастомоз с помощью непрервыного шва. Установлен уретральный катетер Фолея №20 Ch., в артифициальный кишечный резервуар. Результат: способ деривации мочи по методу U.E. Studer при мочепузырном болевом синдроме, способствовал сохранению функции почек, предотвращению кишечной мальабсорбци и избавил пациента от изнуряющего болевого синдрома. Вывод: Замена мочевого пузыря по U.E. Studer является одним из самых перспективных ортотопических способов отведения мочи при цистэктомии., Aim: to present a clinical case of successful application of laparoscopic cystectomy with intracorporeal formation of an orthotopic bladder by the method of U. E. Studer in the treatment of a patient with urogenital pain syndrome. Materials and methods: All stages of the operation were performed intracorporally. The first stage was laparoscopic hysterectomy. After removal of the uterus from the abdominal cavity, mobilization along the anterior wall of the bladder is initiated. Along the intended border, the resected small intestine is stitched with a hardware suture and crossed. The mobilized segment is attached to the urogenital diaphragm with a continuous "Rocco Stitch", then opened throughout. The next step is to form an enterocystourethroanastomosis using a non-ruptured suture. The urethral Foley catheter No. 20 Ch. was inserted into the articial intestinal reservoir. Result: the method of urine derivation according to the method of U. E. Studer in urogenital pain syndrome, contributed to the preservation of kidney function, the prevention of intestinal malabsorption and saved the patient from debilitating pain syndrome. Conclusion: The replacement of the bladder by U. E. Studer is one of the most promising orthotopic methods of urine removal during cystectomy., Жұмыстың мақсаты: Қуық безінің ауырсыну синдромы бар науқасты емдеуде ортотопиялық қуықты U.E. Studer әдісі бойынша интракорпоральды түзілуінде лапароскопиялық цистэктомияны сәтті қолданылу барысындағы клиникалық жағдайды ұсыну. Материалдар және әдістер: Операцияның барлық кезеңдері интракорпоральды түрде жүргізілді. Бірінші кезеңде лапароскопиялық гистерэктомия жасалды. Жатырды іш қуысынан алып тастағаннан кейін қуықтың алдыңғы қабырғасы бойымен мобилизация жүргізілді. Белгіленген шекара бойында резекцияланған жіңішке ішек аппараттық тігіспен тігіліп, кесіледі. Мобилизацияланған сегмент үздіксіз Rocco Stitch тігісін қолдана отырып урогенитальды диафрагмаға бекітіліп бүкіл ұзындығы бойынша ашылды. Келесі сатыда энтероцистоурэтро-анастомоз үздіксіз тігісті қолдану арқылы қалыптастырылды. Жасанды ішек резервуарына No20 фолей уретриялық катетері орнатылды. Нәтижесі: Қуық безінің ауырсыну синдромы кезінде U.E. Studer әдісі бойынша зәрді бөлу әдісі бүйрек функциясын сақтауға, ішектің мальабсорбциясын болдырмауға және пациентті әлсірететін ауырсыну синдромынан босатуға ықпал етті. Қорытынды: U. E. Studer әдісі бойынша қуықты ауыстыру - цистэктомия кезінде зәрді бұрудың ең перспективалы ортопедиялық әдістерінің бірі болып табылады., Наука и здравоохранение, Выпуск 3 (23) 2021, Pages 171-178

In the last 20 years, a concept of using multimodal programs of early rehabilitation of patients after surgical interventions – Enhanced Recovery After Surgery (ERAS) – has been developed in medicine. In oncological urology, the ERAS protocol is used only in treatment of bladder cancer. At the same time, not all available elements of this program are used despite the fact that in Russia 24.4 % of malignant tumors are urogenital tumors, and bladder cancer comprises one sixth (4.6 %) of them. Frequently, reconstructive plastic surgery is an integral part of bladder cancer treatment, and it’s accompanied by various complications many of which are associated with incorrect tactics of perioperative patient care. This situation can be dramatically improved by a more widespread use of the ERAS protocol. The immediate problem of oncological urology is development of an effective, safe, and available for wide use algorithm of postoperative rehabilitation of patients with malignant tumors of the bladder after cystectomy with cystoplasty.

Objective : to identify the most important factors influencing the development of complications after radical cystectomy (RCE). Materials and methods . The results of 182 RCEs performed in September 2014 and December 2016 were analyzed. The patients included 152 (83.5 %) men and 30 (16.5 %) women. The patients’ age ranged from 31 to 84 years (mean age 62.3 years). An orthotopic urinary reservoir was formed in 138 (75.8 %) patients. Postoperative complications were evaluated according to the Clavien–Dindo classification. The calculations were made with a computer program for SPSS Statistics 16. Results. No complications were recorded in 84 (46.2 %) patients within 30 days after RCE. The development of various postoperative adverse reactions was observed in 98 (53.8 %) patients. The most common complications were gastrointestinal (26.9 %) and infectious (25.8 %). Sixteen (8.8 %) patients developed grade I complications; grades II, III, IV, and V complications were seen in 53 (29.1 %), 21 (11.5 %), 5 (2.7 %), in 3 patients, respectively. Thirty-day mortality was 1.64 %. Univariate regression analysis has established that overweight (p = 0.031), T status (p = 0.021), preoperative hemoglobin levels (p = 0.001), intraoperative blood loss (p = 0.009), and intraoperative abdominal cavity infection (p

Introduction. Surgery remains the main method of treatment of patients with bladder cancer, and the only radical surgery is cystectomy with lymphadenectomy and a rationally selected method of urinary diversion. In the Chelyabinsk Regional Clinical Oncological Dispensary, an original method of orthotopic neobladder reconstruction in bladder cancer patients was developed. Objective: to improve the results of surgical treatment and the quality of life of patients with bladder cancer who underwent cystectomy. Materials and methods. The article presents results of a study of patients with bladder cancer who underwent orthotopic ileocystoplasty after radical cystectomy using a unique original technique. The reservoir was formed using a segment of the ileum of 45–50 cm in length with a 20–25 cm offset from the ileocecal junction. It’s important to preserve nutrition of the resected fragment. One of the branches of the ileocolic artery supplies blood to the distant part of the ileum which explains the necessity of the offset. After examination of the mesentery for unusual blood supply, the necessary intestinal segment was resected. Intestinal patency was restored by application of an anastomosis side-to-side with double row suture on the mucosa and serous-muscular layer. The reservoir was formed by application of an enteroenterostomy side-to-side with one row inverting continuous suture. Before that, the resected small-intestinal segment was detubulized (dissected) through the antimesenteric margin for 12–15 cm. Results. This method has the lowest rate of complications; doesn»t affect overall, cancer-specific and recurrence-free survival. Conclusion. The proposed method of neobladder formation allows to significantly improve the results of bladder cancer treatment.

ACL tears are the most widespread lesions among isolated trauma of knee ligaments that require early surgical treatment especially in young active patients. There are various ACL reconstruction techniques where femur and tibia tunnels are formed and graft is fixed by cannulated interference screws. One of the possible complications is the formation of a postoperative soft tissue cyst in the projection of tibial tunnel. The nature as well as mechanism of cyst formation is still unclear.A relevant clinical case of cyst formation in a patient five years after ACL grating is described in this publication. MRI findings demonstrated that the origin of the cyst was hole of the tibial interference screw.Conclusion. The authors observed that synovial cyst was formed due to use of cannulated interference screws where synovial fluid was leaking from joint cavity through screw holes. Cystectomy and autografting of tibial bone tunnel allowed to reduce such complication.

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy. Materials and method s. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve. Result s. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy. Conclusions . Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications.

Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation. Objective: to search for risk factors for complications after RCE with different types of urine derivation. Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43). Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p < 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up. In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho- and/or heterotopic urine derivations rather than to the former. Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeon’s insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation.

Objective: to investigate survival in patients with bladder cancer (BC) after radical cystectomy (RCE). Subjects and methods. Our clinic performed RCE using different urine derivations in 375 patients with BC. There were 324 (86.4%) men and 51 (13.6%) women. All the patients underwent clinical, laboratory, ultrasound, X-ray, and radiation studies. Results. The 10-year overall and cancer-specific survival rates were 43.4 and 47.2%, respectively. In patients without regional lymph node (LN) metastases, the 2- and 3-year overall survival rates were 81.2 and 67.2%. In those with regional LN metastases, the 2- and 5-year overall survival rates were 46.9 and 13.9%. In the negative LN group, the 2- and 5-year cancer-specific survival rates were 83.6% and 70.7%, respectively. In the positive LN group, these were 51.0 and 15.1%. The overall and cancer-specific survival rates also declined with higher tumor stage and grade. Conclusion. Tumor stage, regional LN metastases, and histopathological grade have a considerable independent impact on the overall and cancer-specific survival rates of patients with BC following RCE.

Background. Russia annually notifies 12,700 new bladder cancer (BC) cases; one third of them have invasive forms. Objective: to assess the first results of using balloon procedures to treat ureteroneocystoanastomotic strictures in patients with BC after cystectomies. Subjects and methods. In 2006 to 2013, the Russian Research Center for Radiology and Surgical Technologies, Ministry of Health of the Russian Federation, treated 746 patients, including 69 (9.2 %) patients who were treated by cystectomy for BC. All the 69 patients were preoperatively diagnosed as having locally advanced BC. Urothelial carcinoma was detected in 66 of the 69 patients; 3 patients had squamous cell carcinoma. BC was concurrent with other tumors in 7 patients. Early postoperative complications were noted in 49 (71 %) patients; late postoperative ones were seen in 14 (20.3 %). Ureteroneocystoanastomotic strictures were found in 6 patients; they were all treated using balloon dilation of an ureteroneocystoanastomotic area. Results. Balloon dilation of ureteroneocystoanastomotic strictures was successful in all the 6 patients. The postoperative period was uncomplicated in all the cases. The strictures were removed in all the cases; no hydronephrosis progression was observed during 6–36-month followup periods. Conclusion. As the results of balloon dilation carried out in a larger number of patients accumulate, this may be recommended as a minimally invasive treatment option for ureteroneocystoanastomotic strictures in BC patients after cystectomy.

The purpose of the investigation was to study the long-term results of reconstructive surgery in patients who had undergone simultaneous ureteral and bladder intestinoplasty. The investigation enrolled 33 patients with different bladder diseases complicated by secondary hydroureteronephrosis. After radical cystectomy, the U. E. Studer method was used to form a low-pressure orthotopic reservoir from the ileum with an afferent tubular segment in 23 (69.7 %) patients. Y-shaped ileoureterocystoplasty was carried out to recover extensive ureteral and bladder defects in 10 (30.3 %) cases. Long-term surgical results were assessed on the basis of a comprehensive examination involving laboratory, X-ray, radionuclide, and endourological studies. An isolated loop of the small bowel is a universal plastic material that may be used not only to bilaterally replace any ureteral defect, but also to simultaneously repair the bladder, by preserving independent urination.

Results of treatment of 143 patients who underwent cystprostatectomy or anterior pelvic exenteration. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 71), and bilateral perineal drainage (n = 72). Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Installation is simple perineal drainage performed and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy.

The results of cystectomy (CE) in bladder cancer, performed in the standard and modified modes, were compared. The case histories of 153 patients operated on, by completely or partially preserving the prostate, were analyzed. With the extent ≤ T2N0, the rates of local and distant dissemination after standard and modified CE was 4%/2.1% and 9.5%/10.9%, respectively; i.e. the values did not differ greatly. The data of the performed analysis suggest that the compared values after modified CE are not worse than those after standard CE with orthotopic cystoplasty and do not allow one to doubt the oncological appropriateness in reducing the volume of an operation in specially selected patients.

The article represents the study of quality of life in patients with muscle-invasive bladder cancer stages T2b and T3a after surgery, depending on the operation type. The study was conducted using questionnaires EORTC QLQ-30 and FACT-BL. The best levels of quality of life were observed in patients after organ-saving treatment of muscle-invasive bladder cancer.

The paper analyzes the data on 34 patients with non-muscle-invasive bladder cancer (NMIBC) who have undergone radical cystectomy (RCE). The patients were divided into 2 groups according to the preoperative period: with delayed and early RCE. Heterotopic and orthotopic reservoirs were the methods of choice for urinary derivation. Five-year overall relapse-free survival was 68.9±12.6%. There were differences in the number of relapses in the delayed and early RCE groups. The timely established indications for RCE make it possible to prevent disease progression and to long maintain a good quality of life in the majority of patients with NMIBC.

The paper gives an overview of peri-operative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) as insufficient option, demonstrates a clinical need for the development of more efficacious and safe treatment and introduces a MAGNOLIA study proposed by the European Association of Urology Research Fund in a concept of MIBC immunotherapy. The MAGNOLIA trial conducted in 56 research centers of 10 countries assesses whether adjuvant immunotherapy with recMAGE-A3+AS15 vaccine is safe and effective and improves outcome of patients with MAGE-A3 positive MIBC after cystectomy. 60 of 273 patients have been enrolled. The trial has to be continued to elaborate a general peri-operative treatment strategy for MIBC.

Background. How to derive urine is stemmed from removal of the bladder and from the necessity of its disengaging from the process of urination. Most surgeons prefer to do incontinent urine derivation in elderly and senile patients.Subjects and methods. In 2007 to 2009, the Leningrad Regional Oncology Dispensary treated 103 patients with diseases requiring the bladder be removed. All these patients underwent cystectomy as an independent operation or one of the surgical stages, followed by incontinent urine derivation described by Bricker. The patients were divided into 2 groups: 1) Bricker-type end-to-side ureteroileal anastomosis; 2) Wallace-type one. Group 1 comprised 50 patients: 37 (74 %) women and 13 (26 %) men; Group 2 included 53 patients: 48 (90.6 %) women and 5 (9.6 %) men. These were elderly and senile patients aged 60 to 79 years (mean age 65 ± 3.71).Results. In Group 1, 36 (72 %) patients were preoperatively diagnosed as having hydroureteronephrosis (HUN). Of them, 23 (64%) patients underwent preoperative percutaneous puncture nephrostomy (PPN). In Group 2, HUN was diagnosed in 43 (81 %) patients; of them 27 (63 %) had PPN. Complications and resurgeries were more common in Group 1 (p < 0.001). In Group 2, there were a larger number of cases of incompetence of the ureteroileal anastomosis. This complication required no surgical correction, but a longer drainage standing.Conclusion. The Bricker operation is the safest urine derivation in elderly and senile patients after surgery involving cystectomy. Wallacetype ureteroileal anastomosis during the Bricker operation is accompanied by a considerable reduction in the number of early and late postoperative complications and resurgeries. Wallace-type ureteroileal anastomosis is considered the method of choice in cancer patients.

Criteria for sociomedical examination of patients who have undergone cystectomy with operations of urinary diversion have been currently insufficiently developed. Based on the standard criteria used for sociomedical examination, the authors identify criteria for defining the restricted working ability and disability groups in patients after cystectomy. Estimating the disability group and restricted working ability in patients with urinary bladder cancer after cystectomy should be based on a strictly individual approach, by keeping in mind the complete cancer prognosis, on the integrated assessment made by an expert and a patient himself, on the use of criteria for estimating the quality of life while assessing the degree of restrictions of the basic categories of vital activity. Thus, the estimation should yield an obvious, quantitative result to make an extremely accurate and objective sociomedical examination, which is fully reflected in the use of the questionnaire proposed by us.

Failures of BCG therapy for muscle noninvasive carcinoma of the urinary bladder are classified as BCG refractoriness, BCG resistance, postBCG-therapy recurrences. Some patients are observed to be BCG intolerant, which makes the therapy discontinued. Detectable BCG refractoriness and early recurrences are associated with a high risk of progression and high tumor-specific mortality and are indications for emergency cystectomy. Preference should be given to early cystectomy if high risk group patients have additional poor prognostic factors for disease progression. In patients with BCG therapy failures, medical treatment should be performed only within research programs.